Provider Demographics
NPI:1710226477
Name:COUCH, NANCY (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:COUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:COUCH
Other - Last Name:NOWAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:791 BRADBURN CT
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1027
Mailing Address - Country:US
Mailing Address - Phone:248-347-7842
Mailing Address - Fax:
Practice Address - Street 1:791 BRADBURN CT
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1027
Practice Address - Country:US
Practice Address - Phone:248-347-7842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047051207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine